Mental health needs viewed from two angles

Bert Nash director, undersheriff both have interests in shoring up current system

When David Johnson roams the halls of his office, he's greeted by walls of rich, dark hardwood, soft carpets and warm lighting.

When Kenneth Massey roams the halls of his office, the scene is much different. Cold steel, hard concrete and plenty of peering eyes.

Johnson is the chief executive officer of the Bert Nash Mental Health Center. Massey is the undersheriff in charge of the Douglas County Jail. Their two offices represent the two different faces of mental health care in Douglas County.

They are faces that have been somewhat overshadowed by the recent debate regarding whether Lawrence Memorial Hospital should reopen its inpatient mental health unit. But mental health advocates in the community say leaders shouldn't lose sight of trying to improve the system that still exists in Lawrence.

"What we have currently in the community still needs work," said Alan Miller, the parent of a mentally ill son and a member of a Lawrence task force studying mental health issues. "It is clear to me that we're not where we need to be yet when it comes to mental health care."

Repeat customers

Massey knows one thing that he would like to fix about the system - the revolving door at the Douglas County Jail. It is a door that catches many people with mental illness. Massey said it is not uncommon for the jail to have 30 people, out of an inmate population of 150, who have some degree of mental illness.

Massey said one of the more frustrating parts of his job was seeing the same names show up again and again on the facility's booking sheet. He said he knew several of the people made return trips to the jail, in part, because they hadn't gotten enough help for their mental illness.

"But the only time we can't release them (once their sentence is up) is if we feel really, really strongly that they are going to be a threat to themselves or others," Massey said. "Otherwise, we give them a $9 cab ticket that takes them most of the time back to 11th and Mass., and we'll see them again in a few days."

But it is not that the jail staff doesn't try to help, Massey said. He tells a story about how one inmate was having an episode and the only way he would calm down is if he was allowed to talk to a judge. A member of the jail staff remembered a Web site that featured the voice of the TV personality Judge Judy. The staff member let the inmate listen to Judge Judy via the Internet and the situation was defused.

"Our staff knows the basics of mental health, but by no means do we know enough to provide actual treatment," Massey said.

The jail, though, does have a contract with Bert Nash to provide that type of help. Social workers from Bert Nash come to the jail three to four times per week to talk with inmates, both one-on-one and in group sessions. Bert Nash workers also are on call to provide assistance if an inmate suffers a mental health crisis or needs to be evaluated for placement in a state mental hospital.

But Massey - who is highly complimentary of Bert Nash's work - said there's only so much the social workers can do.

"We're a jail, not a doctor's office," said Massey, adding that the jail setting oftentimes created too much anxiety for an inmate to fully respond to mental health treatment.

Journal-World File Photo

Undersheriff Kenny Massey outside the Douglas County Jail.

Jails across the country are facing the same problems, Massey said. He said part of the solution needed to be a new system to house nonviolent offenders that focused more on treatment than incarceration. The jail is working with Bert Nash to apply for grants that would allow them to explore alternatives.

"We would like to be able to do much more than what we do, but it is a fact of life that you do the best you can with what you have," Massey said. "We desperately need to find another place to house these nonviolent offenders so they can get some treatment."

Easier access

Even better would be getting those people help before they ever reached the criminal system in the first place. That's where Bert Nash has the power to help.

The not-for-profit organization is the one true mental health behemoth in Douglas County. It has a budget of $9 million - about $1.4 million of it comes from Douglas County taxpayers - and a staff of 200 people, including six psychiatrists.

But the question some mental health advocates have about the organization is whether enough people know how to ask Bert Nash for help.

"To the best of my knowledge, Bert Nash is a good institution once you are inside it, but it takes too much exploring, too much groundwork to get involved with the system," said Miller, the mental health task force member.

Johnson said that shouldn't be the case. He said a simple phone call to Bert Nash's offices could get the process started. The phones are staffed 24 hours a day, seven days a week - although during evening and nighttime hours, they are answered by social workers at the Johnson County Mental Health Center. Workers there have a list of telephone numbers for Bert Nash clinicians who are on call. But unless a person is in a state of crisis, there's a waiting list that could be up to several days long for a person to receive treatment.

Johnson said the system was designed to be user-friendly, but noted the process still wasn't understood by all and intimidated some.

"I get calls from people who know me, but still don't know how to access Bert Nash," Johnson said. "Obviously from the comments we have gotten, we know we need to do a better job of communicating what people need to do."

Johnson said part of what is needed is more public education about mental illness itself. In response, Bert Nash is launching an advertising campaign that compares mental health issues with other commonly treated health problems. "You wouldn't ignore chest pains," one ad reads. "You shouldn't ignore your feelings either. Please let us help."

"There is less of a stigma than there has been in the past, but there's still a stigma associated with mental illness," Johnson said. "Some people don't want to admit that they are having trouble getting out of bed in the morning or that they're sad all the time. There are some people who feel like they can pull themselves up by the bootstraps."

More talking

About one in seven people who go through one or more episodes of depression will commit suicide, according to Johnson.

"I remember going to a county commission meeting a while back when SARS (a viral respiratory illness) was all the panic," he said. "SARS has a mortality rate of 2 to 4 percent, and people were very panicked about it. But here we have depression where the mortality rate is 15 percent and nobody is talking about it."

Johnson said getting people to talk about the issue of mental health is one of the more critical needs in the community. He said he's confident Bert Nash has a system in place that can help people if they seek it.

"I think we need for people to be more willing to talk about mental illness and talk to their friends and family and to be able to recognize it in themselves," Johnson said. "That's what would really help us, because we want to have the opportunity to help people before they come to a crisis."

Not so long ago, PBS aired a Frontline special on prisons as "the new asylums" -- focusing on the approach that Ohio has taken to addresssing this problem. If you are interested you view the program online and find links to excellent resources: http://www.pbs.org/wgbh/pages/frontline/shows/asylums/view/

In most places there is no easy relationship between the criminal justice system and the mental health care system, and my impression is that in Lawrence our agencies do the best they can with limited authority & limited resources. Some communities (e.g. Seattle) do have Mental Health Courts, with an emphasis on treatment rather than punishment, but I am not aware of any city in Kansas that uses such a system. Perhaps Douglas County could become a model.

Despite the failings of the system, we are lucky to live in a civilized, compassionate city -- where agencies are responsive to community concerns and where correctional facility mgmt and staff understand that incarcerated people are still human beings who deserve humane treatment -- including attention to mental (as well as physical) health problems.

It is the responsibility of us as community members to educate ourselves on these issues and make our voices heard.

It is now 2008, more than three years later and we still are having exactly the same problems. As I see it, it is due to a profit driven system of mental health. For many years, insurance companies, managed care, and then the government privatization of services with managed care having a majority say over how treatment is delivered, have altered treatment delivery which has closed state hospital beds, psychiatric units and reduced inpatient stays to a point of pointlessness. While day services have improved and medication has improved, it is not enough to compensate for these other changes. In my work, in this field, I have seen too many people die and have seen the mental illness treatment for the severely mentally ill, transferred to the correctional institutes and nursing homes, facilities which were not designed to deal with these problems. These changes are shameful. There is no attempt to inform the public about these problems. There is no attempt or will from the public and legislators to address this most serious of problems. We have gone back to the middle ages in our approach to dealing with the severely mentally ill patients.